Estimating the prognosis of hepatitis C patients infected by transfusion in Canada between 1986 and 1990

Med Decis Making. 2004 Jan-Feb;24(1):20-9. doi: 10.1177/0272989X03261568.


Objective: To develop a natural history model for chronic hepatitis C virus (HCV) infection to determine allocation of compensatory funds to Canadians who acquired HCV through the blood supply from 1986 through 1990.

Methods: A Markov cohort simulation model for HCV prognosis was developed, using content experts, published data, posttransfusion look-back data, and a national survey.

Results: The mortality rate in transfusees is high (46% at 10 years), although HCV-related deaths are rare. Only 14% develop cirrhosis at 20 years (95% confidence interval, 0%--44%), but 1 in 4 will eventually develop cirrhosis, and 1 in 8 will die of liver disease.

Conclusions: This unique application of Markov cohort simulation and epidemiologic methods provides a state-of-the-art estimate of HCV prognosis and has allowed compensation decisions to be based on the best available evidence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood-Borne Pathogens*
  • Canada / epidemiology
  • Cohort Studies
  • Compensation and Redress*
  • Data Collection
  • Fibrosis / economics
  • Fibrosis / etiology
  • Fibrosis / mortality
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / economics*
  • Humans
  • Markov Chains
  • Middle Aged
  • Models, Theoretical
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Transfusion Reaction*